Treatment of Hemophilia A

Hemophilia A can be treated with medication to prevent bleeding. The treatments can include replacements for factor VIII, a blood-clotting protein deficient in people who have this condition. Other specific treatments can be used to prevent bleeding as well.

Lifestyle management for bleeding prevention and control is also an important part of living with this condition. Serious bleeding complications may require specific interventions to reduce harmful effects on your health. This article will discuss the range of treatments for hemophilia A.

Home Remedies and Lifestyle 

If you have hemophilia A, it’s important that you try to avoid injuries. This can mean avoiding contact sports and other known injury risks.

If you get a cut, you might be able to slow down the bleeding by holding pressure over it or by putting ice on it. Don’t place ice directly on your skin—make sure the ice is wrapped to ensure that your skin doesn’t get too cold. 

It’s also important to prevent an infection by keeping it clean and placing a bandage over the open wound until it heals. 

Over-the-Counter (OTC) Therapies 

Sometimes hemophilia A can cause joint pain. Generally, Tylenol (acetaminophen) is recommended to help manage the pain.

There are no OTC therapies that can help treat hemophilia A, but there are some medications that you should avoid:

• Aspirin is commonly used for pain relief, and it is sometimes recommended for prevention of heart attacks and strokes for people who are at risk. Because of the risk of bleeding, aspirin and products containing aspirin are generally not recommended if you have hemophilia A.
• Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, and inflammation may be associated with an increased risk of bleeding for hemophilia A. Sometimes, however, they are recommended for people who have this condition, so check with your doctor before taking NSAIDs.

Prescriptions

Hemophilia A can be treated, but there is no cure. The treatments are used long-term. Replacement of factor VIII is the main treatment for hemophilia A, and this treatment is often referred to as clotting factor. Other treatments can prevent bleeding through biological actions that do not specifically replace factor VIII.

Treatments include:

• Clotting factor products: These include products made from human blood, as well as artificially created factor VIII products. These products are infused into a vein on a regular schedule to prevent bleeding. Your treatment frequency might be adjusted based on the severity of your hemophilia A.
• Hemlibra (emicizumab): This medication works like factor VIII to help the blood clot. This treatment is injected subcutaneously (under the skin). Emicizumab is approved by the Food and Drug Administration (FDA) to treat hemophilia A with or without inhibitors.
• Desmopressin (DDAVP): This treatment imitates the action of vasopressin, an antidiuretic hormone that helps stop bleeding. It is available as a nasal spray or as an injection. Sometimes this treatment is used before or after surgery or when a bleed occurs. However, DDAVP nasal spray has been recalled by the manufacturer until 2022.
• Amicar (aminocaproic acid): This medication is taken by mouth as a pill or liquid to prevent the breakdown of blood clots. Your doctor might prescribe this for you if you have a bleed or before you have a surgical procedure.

Joint pain can be treated with prescription medication, including prescription-strength NSAIDs that do not affect bleeding.

Inhibitor Treatment 

One of the problems that can develop with clotting factor treatment is the development of inhibitors. This is an immune reaction that causes the body to destroy the clotting factors, making them ineffective. Treatment of hemophilia A is complicated by the presence of inhibitors. 

Some treatments you might need if you develop inhibitors include:

• Hemlibra (emicizumab): The inhibitors do not act against this medication.
• Bypassing agents: Products that promote blood clotting without imitating factor VIII may help prevent bleeding episodes.
• Immune tolerance induction (ITI) therapy: This treatment involves large amounts of factor VIII products that may cause the body to eventually stop making inhibitors.

Surgeries and Specialist-Driven Procedures

Surgery is not a treatment for hemophilia A, but sometimes surgery might be necessary in cases of severe bleeding, such as to remove blood that is pooling in the body or blood that is causing pressure on the organs. Surgery poses a bleeding risk for people who have hemophilia A, so this is not considered a standard approach.

Complementary and Alternative Medicine (CAM) 

There are no CAM therapies that can help prevent bleeding in hemophilia A, but several therapies are used to help manage some of the effects of hemophilia A. Because this condition predisposes you to bleed, you must be cautious about any CAM therapies. Discuss it with your hematologist (a doctor specializing in blood disorders) before trying any CAM therapies.

Therapies that may be helpful include:

• Manual therapy: If you develop joint stiffness due to bleeding and joint damage, your
  physical therapist or occupational therapist can move your joints or give you instructions for joint motion to help improve your range of motion.
• Acupuncture: This therapy may help with the pain. Since this treatment traditionally involves the placement of needles into the skin, check with your hematologist before considering this therapy and make sure your acupuncturist is aware of your tendency to bleed.

Summary 

Hemophilia A is a chronic disease that requires lifelong management. Replacement of factor VIII is the cornerstone of medical management for this condition. Treatment is aimed at preventing bleeding, and there are also treatments that can be used if you have a bleeding complication.

Your medication may be adjusted based on your response to treatment and your symptoms. Inhibitors, which are the body’s immune response to factor VIII replacement, can make factor VIII replacement ineffective. Your doctors will give you different treatments and reduce your level of inhibitors if you develop this problem.

A Word From Verywell

The treatments for hemophilia A have advanced substantially over the past years. This means that you, and any of your family members who have the condition, may benefit from the available therapies.

Living with hemophilia A means that you will need long-term treatment to prevent bleeding episodes. You must try to avoid injuries, control bleeding, and protect any wounds that you develop. Talk to your doctors about additional treatments you might need to prevent bleeding before you have any scheduled surgical procedure.

If you develop complications, such as joint stiffness and pain, therapy can help you improve your joint mobility. Research is ongoing regarding the potential of gene therapy as a treatment for hemophilia A.